Consultation on the future of Attendance Allowance: What questions do we need to ask?

In this post, Steve Pudney, a member of the UKAJI team and Director of Research at the Institute for Social and Economic Research, University of Essex, explores the questions for researchers in relation to the proposed transfer of responsibility for a key disability and social care benefit from central to local government.

Britain currently has a dual system of public support for older disabled people. The Department for Work and Pensions (DWP) provides the non-means-tested disability benefit Attendance Allowance (AA), while local authorities (LAs) provide means-tested subsidies for social care services. Far more older people currently receive AA than LA social care support.[1] Just before last Christmas, the Government announced its plans to consult on a proposal to transfer responsibility for a central pillar of its disability support for older people from DWP to LAs:

The Government will also consider giving more responsibility to councils in England, and to Wales, to support older people with care needs – including people who, under the current system, would be supported through Attendance Allowance. This will protect existing claimants, so there will be no cash losers, and new responsibilities will be matched by the transfer of equivalent spending power. The Government is planning to consult in the New Year on this proposal, including on the right model of devolution and the level of flexibility that councils would need in order to effectively deliver this additional responsibility. (DCLG, 2015)

The promised consultation has not yet materialised and we do not know what specific questions the consultation will pose. I have my own list of six major questions that arise in relation to this proposal:

How would it affect the targeting of public support on those with greatest care needs and lowest incomes?

How easy will it be to access support from LAs rather than DWP?

What implications will there be for the administration costs of the system?

How good is the accuracy of LA claims assessment compared to DWP?

How effective is the system for challenging decisions made by LAs rather than DWP?

How easy is it to monitor and research the service delivery of LAs compared to DWP?

There is remarkably little evidence about some of these crucial questions. On targeting, we know quite a bit about AA (which is surprisingly well-targeted, despite its non-means-tested nature[2]), rather less about the pattern of LA social care subsidies, and almost nothing about how LAs would aim to meet their new responsibilities. On access, we know rather little about the reach of AA and LA social care support, especially the volume of unmet need (the number of cases where a successful claim could be, but has not been, made). On administration costs, although it is often confidently asserted that they will be reduced by integration, it is not obvious that expansion of a geographically fragmented system run by LAs will achieve cost savings.[3]

That leaves us with issues [4], [5] and [6], which are firmly in the field of administrative justice. The workings of the current systems for challenging DWP and LA decisions should tell us something about them – although only a partial picture is possible, since we do not see potential challenges that were never brought forward.

For AA there is a formal two-stage system: claimants can request mandatory reconsideration by DWP and, if unsuccessful, appeal to a tribunal operating independently of DWP under the auspices of HM Courts and Tribunals Service. Table 1 summarises the outcomes for 2011/12, showing that the majority of challenges are successful – overturning up to 16% of DWP’s initial rejections.

1 Sources: Hansard written answer HC Deb, 17 January 2012, c644W; Ministry of Justice: Annual Tribunals Statistics, 2011-12; 2 Successful reconsiderations and appeals as % of number of reconsiderations. 3 This ratio is an upper bound on the success rate in challenges to rejections of initial claims, since some challenges are to the award of a lower rate of benefit rather than the rejection of a claim.

Although the accuracy of DWP decisions seems to be less than one might wish, the process is at least clear and easily subjected to scrutiny. The same cannot be said for the LA social care system, where the procedure for problem resolution and redress has four strands.

Informal request to the LA’s adult social care professionals to review the decision. If that fails to resolve the problem:

Formal complaint under the Social Services Complaints Procedure, which every LA is required to provide. The complaint is investigated and assessed by the LA itself. The way this happens can vary and may be negotiated between the complainant and the LA. If the complaint is not upheld:

Complaint to the Local Government Ombudsman (LGO), who has powers to facilitate agreement and make recommendations. The LGO has no power to order the LA to make changes, but recommendations are usually complied with.

Legal challenge by judicial review – very much a last resort.

In parallel to this system is the possibility of registering a concern with the Care Quality Commission, which deals with the appropriateness and standards of care received, rather than other aspects of LA decisions.

Although each LA is required to publish an annual complaints review, there are no harmonised national summary data comparable to that relating to AA. The LGO does now publish statistics on complaints relating to adult social care,[4] but these cases cover only a (probably small) minority of initial challenges to LA decisions.

It is not enough for administration to be fair and efficient – it must be visibly so. That means that we will need good data on the working of any new system, both at the local level with comparability across LAs, and at the national level to give an overview of the system as a whole.

The coming consultation is a valuable opportunity to reconsider the delivery of social care services and improve the processes for monitoring and challenging decision-making. We really need the consultation to be well-designed – it must specify the proposed reform(s) clearly and then ask the right questions. We’re waiting with bated breath….

Hancock, R. M. and Pudney, S. E (2013). Assessing the distributional impact of reforms to disability benefits for older people in the UK: implications of alternative measures of income and disability costs. Ageing and Society34, 232-257. http://dx.doi.org/10.1017/S0144686X1200075X

[1] In 2015, approximately 14% of the English over-65 household population received AA, compared with 2.5% receiving LA social care in their own homes and 4.2% if we include care home residents (Hancock et al 2016).